Reuters Health

Tuesday, December 3, 2002

Tue December 3, 2002 01:44 PM ET

By Charnicia E. Huggins

NEW YORK (Reuters Health) - Contrary to many experts' predictions, infants born to mothers who used cocaine heavily during pregnancy do not seem to have developmental delays in early life, new study findings show.

During the cocaine epidemic in the US, in the late 1980s and early 1990s, many expected that children exposed in the womb to their mother's cocaine use, or "crack babies," would suffer lasting developmental impairment.

However, the idea that these children are "doomed at birth" is not consistent with the present study findings, which looked at children up to the age of 2 years, or with previous research, lead study author Dr. Deborah A. Frank of Boston University's School of Medicine in Massachusetts, told Reuters Health.

"This stereotype does as much harm, if not more, to children as the actual physiological impact of prenatal exposure," Frank added. "The negative expectations of these children are in itself very harmful."

Frank and her colleagues studied 203 mother-infant pairs, including mothers who were heavy cocaine users, meaning they had used cocaine on more than 62 days during their pregnancy; light users; non-users and their full-term infants. The infants' psychomotor and mental development was tested at 6, 12 and 24 months of age. Psychomotor function involves physical activity that is linked to mental processes, for example learning to grasp an object or to crawl or walk.

Overall, infants who were exposed to high levels of cocaine did not have a higher risk of mental or psychomotor developmental problems, the investigators report in the December issue of Pediatrics. But they did have slightly lower scores if they were also lower birth weight infants, the report indicates.

In general, lower birth weight infants--regardless of their cocaine exposure--did not perform as well on tests of their mental abilities as their normal-weight peers, but those who were also exposed to high levels of cocaine scored lower on mental and psychomotor tests.

The reason for this may be due to social factors, including the infants' home environment, study findings suggest.

Infants who were heavily exposed to cocaine were more likely to have been taken out of their mother's custody and placed with unrelated foster parents, the authors note. Those who were cared for by another family member, however, had more developmental problems at later ages than did infants who were left in the care of their biological mother.

Related caregivers are not always properly evaluated and monitored--as are foster parents and biological mothers with a history of drug use--and may not have the necessary support and resources necessary to provide the best care for the infant, Frank explained.

In other findings, all of the infants scored lower on their developmental tests as they got older. "That's the sad news," Frank said. "Poverty corrodes child development.

"But for everybody, early intervention helped to decrease the magnitude of that decline," she added.

Early speech, physical therapy and other intervention services seemed to protect heavily cocaine-exposed infants against problems in their mental and psychomotor development, study findings indicate.

In fact, the heavily exposed infants who received early intervention performed better in tests of their mental development than less-exposed or non-exposed infants. This may be because infants exposed to high levels of cocaine were more likely to get such help earlier--before their first birthday--than their peers, the researchers speculate.

In general, the development of cocaine-exposed infants "very much depends on what happens to them after they are born," Frank said, citing the importance of appropriate caregivers and intervention.

Further, cocaine-exposed infants can benefit from the same types of intervention programs that every impoverished child at risk for developmental problems needs, Frank said. "People need not be scared to enroll these children in the same programs." The cocaine-exposed children "didn't need anything extraordinary," she added.

Finally, to ensure that cocaine-exposed infants placed in the care of a relative receive the same quality of care as their peers, pediatricians should "advocate for measures to decrease caregiver burden, increase resources, and enhance supervision for caregivers providing kinship care to the level of that provided for unrelated foster parents," the researchers write.

"You have to support the children, and you have to support the caregiver, whoever it is," Frank said.

Grants from the National Institute of Drug Abuse and the National Center for Research Resources funded the study.